Beyond what meets the eye: unveiling dynamics of compliance with preventive measures in the COVID-19 era

Background: Previous longitudinal studies identified variability in compliance with COVID-19 preventive measures, noting the heightened sensitivity of the least compliant groups to situational factors like easing restrictions. However, they overlooked other forms of variability inherent in compliance behaviour. Hence, we investigated compliance with social distancing and staying-at-home measures, and its dynamic nature, along with its association with social and individual factors. Methods: Data from a longitudinal study involving 1984 Canadians across six time points from April 2020 to July 2020 were analyzed. Compliance levels were assessed through self-reported items, alongside social and individual factors like trust in Canadian health services and in the Prime Minister, perception of social norms, and subjective health literacy. Results: Latent Class Growth Analysis revealed three compliance trajectories during mandatory and lifting measures periods: “Low and constant” (shifting to “Low and decreasing” during lifting measures), “High and decreasing,” and “High and constant” for both preventive measures (social distancing and staying-at-home). Most Canadians belonged in the “High and decreasing” trajectory during the mandatory and lifting measures periods: 53.68% and 54.89% for social distancing; 51.71% and 53.48% for staying-at-home. Subjective health literacy consistently predicted membership to trajectories of compliance with preventive measures. Transition movements between trajectories mostly showed stability (between 86.83% and 91.55% for social distancing; between 80.24% and 88.69% for staying-at-home). Two factors, namely perception of provincial norms and trust in Canadian health services, were moderate predictors of transitions toward higher compliance trajectories for both preventive measures during the mandatory and lifting measures periods. Conclusions: Our study not only reaffirms variability in compliance patterns within the lowest compliance group but also unveils variability among higher compliance groups, notably in trajectory transition movements. Subjective health literacy consistently emerged as a strong indicator of trajectory membership, while perception of provincial norms and trust in Canadian health services moderately influenced trajectory change.